Marilyn Maia Nguyen

Primary specialty

DentistTaxonomy code 122300000X

License

101758 Issued in CA

Practice address

16475 Sierra Lakes Pkwy Ste 140
Fontana, CA 92336-1259

Phone

(909) 357-0869

NPI assigned

Jan 29, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jefferson and Chokka Dental Corporation

  • General Practice Dentistry
  • Fontana, CA
  • NPI 1902003593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1588022065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15642 SAND CANYON AVE PO BOX 51443",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92619",
            "telephone_number": "415-857-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16475 SIERRA LAKES PKWY STE 140",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361259",
            "telephone_number": "909-357-0869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MARILYN",
        "middle_name": "MAIA",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-29",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101758",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101758",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jimmy Nguyen
• Kathlene Manimtim Nguyen
• Khoa Anh Nguyen, MD
• Kim Bich Thi Nguyen
• Loc Nguyen, MD
• Ngoc Patrick V Nguyen, MD
• Patrick Nguyen
• Pheobe Nguyen, O.D.
• Phong Van Nguyen, PHARM.D
• Phuc Nguyen

• Dentist in Fontana, CA
• Providers in Fontana, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.